Provider Demographics
NPI:1174977425
Name:PAUL N GOTKIN, DPM & DAVID A GUBERNICK, DPM PA
Entity type:Organization
Organization Name:PAUL N GOTKIN, DPM & DAVID A GUBERNICK, DPM PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUBERNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-286-9912
Mailing Address - Street 1:2291 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4516
Mailing Address - Country:US
Mailing Address - Phone:772-286-9912
Mailing Address - Fax:772-286-2405
Practice Address - Street 1:114 N PARROTT AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2918
Practice Address - Country:US
Practice Address - Phone:863-484-8001
Practice Address - Fax:772-286-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
77424Medicare PIN
1319690001Medicare NSC